Vitamin A Supplementation in Treatment for Acute Shigellosis

Summary of published paper

Shigellosis is one of the most severe forms
of infection to affect the intestine. The infection is associated with
malnutrition, growth stunting and high mortality. In recent emergencies
it has been one of the major causes of mortality. In the Great Lakes emergency
of 1994 cholera was said to claim 30,000 lives in the Goma camps yet 46-63,000
people were said to have perished from dysentery (shigella Dysenteria
type 1). The worst outbreaks in the region were in the IDP camps in south
West Rwanda were incidence rates of over 30 cases per thousand were reported
at one time.

Evidence that vitamin A has a physiological
role in maintaining epithelial integrity and in stimulating immune function
suggests that it may prove a useful adjunct to antibiotic treatment
in shigellosis. However, up until now there have not been any evaluations
of the role of Vitamin A in treatment of acute shigellosis. Current guidelines
on treatment of shigellosis do not advocate use of vitamin A in the treatment
of this disease.

A study has recently been completed by
the international Centre for Diarrhoeal Disease Research which is based
in Dacca, Bangladesh. The objective of the study was to evaluate the efficacy
of a single large oral dose of vitamin A in treating acute shigellosis
in children in Bangladesh. The research involved a randomised double blind
controlled clinical trial on 83 children aged between 1-7 years with bacteriologically
proven shigellosis but no clinical signs of vitamin A deficiency. The children
were given a single oral dose of 200,000Iu of vitamin A plus 25 IU of vitamin
E or a control preparation of 25 IU of vitamin E.

The results of the study showed that treatment
of the disease with a single oral dose of Vitamin A along with a
standard anti-biotic regime reduced the severity of the illness in children
aged more than one year old. However, it did not accelerate bacteriological
cure. It was suggested that the vitamin A probably worked in two ways.
First, as it is adequately absorbed across the gut lining even during episodes
of acute diarrhoea, it is available to the lining of the colon almost
immediately after absorption and may have enhanced repair of the micro-ulcers
associated with the disease. Secondly, shigellosis affects epithelial tissues
extensively and causes an intense inflammatory response. As Vitamin A
has an effect on stimulating the immune system it may reduce this response.

The conclusion of the study was that vitamin
A supplementation should be added to the standard treatment for acute shigellosis
for children in countries where vitamin A deficiency is a major public
health problem and shigellosis is endemic.